HomeMy Public PortalAbout10547 OLIVE ST_Sewer__ F(308 APPLICATION FOR ERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING ANIS SAFETY DIVISION FA
G
JOHN A. LAMBIE, County En46neez ADDRESS -
WILLIAM A. JENSEN, Sup't of building y
LOCALITY
T --- -
CROSS S
PP ICAN TO FILL IN _ _-
CR AT
MAIL
BLOCK TRACT _ ADDRESS
NO, OF BLDGS.
SIZE" OF LOT NOW ON OT ,^ CITY TEL. NO,
BUILDINGS
OF
tlUILD NGS .� �W� � a.+'"L- D.157R;C7 NO. GROUP MAP PR�1:C�SSED 9Y
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CONTRACTOR
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ADDRESS
-CONNECTION DATA
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NO. -- ^�^ _: ��y�✓ -- _ - -_ _
rdECFSTRATION NO_--_ COUNTY MANHOLE REFERENCE t e� L- 3WE _
WER �.
NO.F GESCRIF' IOtN OF WORiS-__FEE _-_ _ TYPE OF CONNECTIIAr J-- LENGTH FROM _
,j
HOUSE SEWER CON Ne CTING TC, - -.- Y. CUR P L M.L TO Y.V_.
y PU3LIC SEWER C«� $ :GO ~ I "'f __ „�. _..� yFr .� -__ __. _-- _�_-__. 0
d SEP AND/OR
5R'EPAG P.'Y Oss TRUNK PERMIT'
PTS f•JD�4R DRAIi'JF t<D 3 .DO CO.IMP NO r' '37 JOS NO
HOUSE SEWER CONN c TING TO 1 NO '' OA PERMIT N
PRIVATE'D SPO'AL SYSTEM @ .33 40 ROAD PE �, �,
__ _ _ - -____- - TTT -._- r�-
O RK o ALDIT ONAL BLDG OR AFFIDAVIT WAIVER EASE kE.NT l RECOIL'... INSTR NO: DATE -
1
9
WORK 70 HOUSE SEIWER �' $ DO I
- -._
.Od R :..OW EPAGE- PIT,Dn__AlN FIELD
r
CX7N CESSPOOL.tDR WE L,MkNHQLE 1@ %500. -- --- - - — - 1---------
WIDENING OR ST
HWY. .
'I ALTER,REPAIR OR A6A NDU'N F(CJ7.ISE -
SEWER
.C...R aISPO5_AL_ SY.-S_T-EM_ $_3_ -}
STA-YE..-
ENCROACHMENT.
PERMIT NO
INDUSTRIAL (
_ r �
l WASTE APPROVAL '(„?,.9 �sr '>e�
OV9"A ES P IT pp _ CHARGES
__ CONNECT ON CHARGE FEE
AUTHORIZATION TOTAL FEE �' - - --- --- --- - --
I HAVE AT l'HiS DATE A CONTRACT' WITH THE HEREIN NXME -
REIMBURSE M[9E NTgfyEc
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -_-.APPROVALS
__
TO THE PURL DATE I4 SEWFR. NSP£CTOR S SIGNATURE
SIGNED THIS ______—_,.DAY OF----------,19� "---- - --- -.--.. —. — --
OWNER OR NEW HOUSE SEWER
-- - -- - --
OWNF_HS ACaE NT_-_—._._. CONN ECT ADDITIONAL I
ADORESS BUILDING OR WORK
PTIC TANK„SEEP P.T(S)
I HEREBY ACKM OW LEDG THAT 1 HAVE READ '1'H] APPLICATION ANU!OP DRAINF ELD 'I .
AND ATF '.-NAT THE ABOVE i5 CURREOT AND .AGREE TU CDAAPL.V
W]T'H ALL .OUNT'Y ORDINANCES AND SIA,E. LAWS REGULATING CESSPOOL �. DRYW.E LL Q � -
P:_UM3iNG AND SEWERS.
�-
HEREBY CERTrFY THAT 1 AM. PROPERLY REGISTERED AND/OR OR ALTs R,REPAIG2,SEWER OR
. E ..r-- -- -----
I_IG.FNtSED AS REOWRE0 BY LOS- ANGLES COUNTY AND STATE. Of SEWAC',E DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OW N£R OF, AND INTEND TO
RE,SiDF :Fd, THE A.60 ESt.RI tC RESICENTIA PROPERTY'' 1:1115CONNEC:T PLUG AND
\UANDON HOUSE SEWER -
SIGNATURE
LSF PERMITTEE , _+ J ✓�°�?,�_ BACKFILL SEPTIC TANKS u
�_EP,
P_f IS) [:1CESSPOOLS
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
r CK. M.O. CASH
y,
3
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION
'j"D'N
ij I I-n I N G
JOHN A. LAMBIE, County Engineer ADDR 9
'A _F
- ESS-
WILLIAM A. JENSEN, Supt of Building
LOCALITY
NEAREST
05
CR..S ST.,
QR APPLICANT TO FILL IN
pT I ON ._0T NC& lee, OWNER
44de
MAIL
BLOCK, TRACT ADDRESS
NO. OF BLDG.$.
SIZE OF LOT NOW ON LOT CITY TEL, NO.
USE OF
B_ULDINGSDIS'TRjCT NO.
GROUP
I MAP
PROZ�SSED BY
_ _ -- ---- B
P
K
10 > -ss
ADDR_S` I- CONNECTION DATA
J/
DEPTH
f T ATION /W
TEL� N10.
TATE
REGISTRATION NO, C Y -MANHOL.E REFERENCE
LOWER
UFSCR]FTI(�NO 114Z
LENGTH FR .
NO. F WORK FE5. TYPE OF CONN 4�'
CON-_ M4GT6 Y. Cyp's
_T_H_66SESEWER NN E C�i M-L.TO
I PUBLIC SEWER Q
$s.00
- ------ DB NO-
U
fANK,SEEPAGE PtT OR GO, IMP.NO. j
PIT�,AND/OR DRAINFIELD @ SIO-00 -0
h SEWER CONNECIING TO11� ROAD PERMIT NO.
TRUNK 11
a 0
I PRIVAfr D FO AL SYSTEM s"3.00
AF1 R] 'N��Nal DATE
CCIIHNEC.-i ADOIiONAU BLDG.OR WAIVER EASEMENT RECORD.
WOHK TOHGJSE SEWER @ S3.00
CSV ERF�LOVV 5EEFAIE PIT,DRAINFIELD
EXTN_C_SSFOO L DRYWEk.L,MANHOLE.@ $5.00
z
LR I HWY, OR ST_WIDENING
1111 NEON HOUSE
SYSTEM *3_00
STATE ENCROACHMENT
fy. PE RMIT NO.
STRI-AL
WASTE APPROVAL
CHARGES
OAINEE`SI-PER'MIT
CONNECTION CHARGE FEE
AUTHORIZAT,,ON TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIPBURSFMENT FEE
TRACTOR TO.
CONNECT
ON NECT THE ABOVE DESCRIBED PXISTING DWELLING -------—- --- — -_ __D.,,_TE_T_INSPECTOR'S_ . ____
P
TO THE UBLIC SEWER. APPROVALS SIGNATURE
SIGNED THIS DAY
OWNER OFI.
NEW HOUSE,SEWER
OWNERS CONNECT ADI-17-fONAL
BUILDING OR
WORK
HAVE READ T SIEPTICTANK,SEEP,PIT(5)
1 Y ACISNC'WLEDG
HE THAT I Hj� APPLICATION AND/OR CIR.AIN51ELD
A r, AT "HE ABOVE IS CORRECT ANO AGREE TO COMPLN
N_ STATE TH4 H -_ _d_
IN!T H ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS- CESSPOOL. DRYWELL
i H PROPERLY
HEREBY CEPTiFY THAT i AM REGISTERED) ANO/OR ALTER,REPAIR,SEWER
OR
LICENSFD AS REQUIRED L OS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL,SYSTEM
C I ED By H D INTEND TO
ALiFQRN A DR THAT ! AM. T K LEGAL. OWNER OF, AN DISCONNECT PLUG
RESICE 1NA, -E DE-C, THE E ISEN
ED RESIDTIAL RT
'Y. ABANDON HOUSE 5IEWE�R
SIGNATURE
OF PERM.ITTEM BACKFILL SEPTIC TANKS
SEEP,PIT T5) CESSPOOLS
ROBERT A. WOOD
SUPERVISING NIECHAWCAL ENGINEER
hi KM O. CASH
J